A systematic approach to the design and scale-up of targeted interventions for HIV prevention among urban female sex workers

HIV transmission continues to be a significant global health challenge that requires targeted prevention activities implemented strategically and at scale for high-risk populations. The development and implementation of evidence-based HIV prevention programmes designed to reduce transmission in the context of female sex workers (FSWs) is a strategic priority for HIV prevention. This document describes a systematic approach developed by the Karnataka Health Promotion Trust (KHPT) for the design, implementation, and evaluation of strategic HIV prevention programmes targeted at urban FSWs. The purpose of this document is to provide practical guidance for policymakers, programme managers, and implementing organizations in designing, implementing and scaling-up HIV prevention programmes targeting urban FSWs. This document outlines strategies to rapidly establish core programmes as part of macro-planning. As part of micro-planning, service delivery is refined through the use of problem solving tools and the establishment of routine monitoring and evaluation activities. The approach described here to design and scale-up targeted interventions is appropriate for interventions targeting any vulnerable population and has been used in India, Sri Lanka, Pakistan, Bhutan, and China not only for urban FSWs, but also for injecting drug users, men who have sex with men, and male and transgender sex workers. This approach can be used without paper-based systems and can be implemented at a variety of geographic levels, including state and district level. Several key messages are highlighted throughout this document. First is the underlying assumption of the strategic importance of HIV prevention interventions among FSWs. Second, populations of FSWs are not homogeneous, and mapping is essential to understand the local context and dynamics of HIV transmission. Third, HIV prevention programmes should be implemented at scale to ensure high population coverage. Fourth, in targeted HIV prevention programmes, micro-planning is needed to ensure that the intervention mix is right for the local context and that there is sufficient community involvement and ownership to ensure it is acceptable. Fifth, the vulnerabilities faced by FSWs need to be addressed through empowerment and community collectivization for comprehensive and effective HIV prevention programmes. Finally, monitoring and evaluation strategies can provide opportunities for continuous improvement in programme performance.